EXAM 4 Drug Cards Flashcards
Diphenhydramine (Benadryl) [Class: 1st gen antihistamine, also an antitussive]
MOA: blocks H1 receptors → competes with histamine/occupies receptor sites
(highly protein bound)
o Uses: allergic rhinitis, common cold, motion sickness
o Side effects: most 1st gen antihistamines cause drowsiness, dry mouth, fatigue,
anticholinergic effects (4 can’ts - can’t see, can’t pee, can’t spit, can’t shit)
o Interactions: can cause CNS depression with alcohol, narcotics, hypnotics, or
barbiturates. No MAOIs
o Client teaching: remember it causes drowsiness → no driving/operating heavy
machinery; administer in large muscle for IM injection – avoid subQ injections
▪ Needs at least 30 mins to work for motion sickness
▪ Crosses into breast milk
▪ Paradoxical effect especially in children = agitation, insomnia
▪ Older adults may experience urinary retention, confusion, painful
urination (more sensitive to effects)
Dextromethorphan hydrobromide (Robitussin) [Class: Antitussive]
MOA: disables the cough receptor zone
o Therapeutic effect: suppresses nonproductive cough → promotes a productive cough
o Side effects
▪ CNS effects, fatigue, GI distress
o Client teaching:
▪ Restrict activities that require mental alertness
▪ Increase fluids to decrease viscosity of secretions
▪ No Alcohol, antihistamine, antidepressants, opiates → increases CNS
depression
▪ Hypotension and hyperpyrexia with MAOIs
Tiotropium (Spiriva) [Class: anticholinergic]-
MOA: blocks muscarinic cholinergic receptors and antagonizes acetylcholine action
▪ Uses: bronchospasm associated with COPD
o Side effects: chest pain
▪ Most common adverse effects of tiotropium include dry mouth, constipation,
vomiting, dyspepsia, abdominal pain, depression, insomnia, headache, joint
pain, and peripheral edema.
o Contraindications: hypersensitivity
▪ Caution: Lactose, glaucoma, renal impairment, older adults
o Client teaching:
▪ Has a rapid onset of actin and a long duration
▪ Administered by inhalation only with HandiHaler device
● should be washed with warm water and dried.
▪ Assessment: Breath sounds, wheezing, any cough? → include in assessment
▪ Not immediate-acting, not a respiratory, improvement in 5-10 days
▪ Hydration, regular intervals (ATC), wash Handihalers with warm water and
dried
Albuterol (Beta 2 adrenergic agonist)
MOA: stimulates beta 2 receptors in lungs to cause bronchodilation
o Indications for use: asthma and bronchospasm
o Side effects: hand tremors, tachycardia, palpitations → normal
o Client teaching
▪ Patients with diabetes should be taught to closely monitor their serum
glucose levels
Montelukast (Singulair) [class: leukotriene receptor antagonist]
Indications for use: treatment of allergic rhinitis and asthma, for exercise-induced
bronchospasm prophylaxis
o Therapeutic effects: dilates bronchi
o Client teaching:
▪ No St. John’s Wort – can lower therapeutic concentration
▪ No green/black tea
▪ Monitor liver function
▪ Drink fluids
Pantoprazole (Protonix) [PPI]
MOA: reduce gastric acid by inhibiting hydrogen/potassium ATPase
● Statins increase PPI absorption and bioavailability
● Food decreases peak levels
▪ Indications of use: GERD, NSAID induced ulcers
▪ Adverse effects: GI bleeding, anemia, hypomagnesemia, tachycardia,
palpitations
▪ Caution/contraindications:
● Hypersensitivity
● Caution: Hepatic impairment, pregnancy, breastfeeding, diarrhea,
bone fractures, osteoporosis, older adults
▪ Course of treatment:
● Take before meals
Promethazine (Phenergan) [class: antiemetic]-
MOA: blocks histamine 1 receptors– acts on CTZ
▪ High alert med via IV
o Interactions:
▪ No alcohol or other CNS depressants
● No driving
●
▪ Lowers seizure threshold with phenytoin and tramadol
▪ May cause false pregnancy test → avoid during first trimester
o Side effects:
▪ Drowsiness, dizziness, confusion, anorexia
▪ Anticholinergic effects
Famotidine (Pepcid)- [histamine 2 blocker]
o indications for use: mainly effective in treating gastric and duodenal ulcers → also
symptoms of pyrosis, dyspepsia, GERD, and Zollinger-Ellison syndrome.
o mechanism of action: inhibits binding of H2 receptors [blocks h2 receptors]→
reduces gastric acid secretions
o interactions:
▪ Administer before bed
▪ Avoid food and liquids that cause gastric irritation
▪ No antacids
Sucralfate teaching (pepsin inhibitor)
indications for use: GI ulcers
o mechanism of action: combines with protein to form thick paste covering ulcer from
acid and pepsin
o nursing considerations:
▪ Administer on empty stomach –before meals and at bedtime
▪ Increase fluids
▪ Monitor severe constipation
▪ Avoid liquids and foods that can cause gastric irritation
o client teaching:
▪ SEs: constipation, flatulence, dizziness, HA, dry mouth
▪ No antacids → decreases effects
▪ Relief after 1-2 weeks ‘
▪ Stop smoking
Aluminum hydroxide (antacid)
Indications for use: neutralize HCl and reduce pepsin activity
o Side effects: constipation
o Contraindications:
▪ caution in renal/hepatic disease/dysfunction
o Nursing considerations.
▪ Do not administer with oral drugs → delays absorption
▪ Monitor electrolytes
▪ 2 oz of water after taking antacid to ensure drug reaches stomach
▪ Therapeutic effect is not immediate → takes a couple of weeks
Diphenoxylate with atropine (Lomotil) [antidiarrheal
MOA: inhibits gastric motility on smooth muscle cells in GI. diphenoxylate is an
opioid that slows intestinal motility, atropine added as an anticholinergic – dry out
the watery diarrhea.
o Therapeutic effect: treat diarrhea by slowing intestinal motility → stops diarrhea
o Side effects: Drowsiness, dizziness, diarrhea, euphoria, anticholinergic SEs
o Nursing considerations:
▪ Assess BS, VS → esp respirations
▪ Monitor for s/s dehydration
▪ Drug may be withheld if diarrhea continues for more than 48 hrs
▪ Drink fluids
Solifenacin succinate (Vesicare) [antispasmodic]
mechanism of action: control an overactive bladder, which causes frequency in
urination.
o therapeutic effect: controls urinary incontinence
o side effects
▪ Anticholinergic effects: blurred vision, headache, dizziness, dry mouth,
constipation, and tachycardia.
o adverse effects
▪ Pts should report urinary retention, severe dizziness, blurred vision,
palpitations, and confusion.
o nursing considerations
Clomiphene (Clomid):
indications for use: promotes induction of ovulation
o mechanism of action: competes for estrogen receptors within the hypothalamus
o side effects:
▪ breast discomfort, fatigue, dizziness, depression, nausea, increased appetite,
dermatitis, urticaria, anxiety, weakness, heavier menses, vasomotor flushing,
and abdominal bloating or pain.
▪ Antiestrogenic effects → may interfere with fertilization or implantation
▪ Adverse: bloating and stomach or pelvic pain, photophobia, diplopia, and
decreased visual acuity.
Metformin (Glucophage) [Class: Biguanide]
only in oral form/most noninsulin antidiabetic
frequently prescribed
o MOA: suppresses glucose output by the liver, as a result decreases glucose,
triglyceride, and cholesterol production in the liver. Decreases glucose absorption
in the gut, increased targeted cells’ insulin sensitivity. Benefits patients with type 2
DM who are obese and/or hyperlipidemic because it decreases weight, blood
pressure, and plasma lipid levels.
o Side effects:
▪ does not produce hypo- or hyperglycemia, can cause GI disturbances
o Interactions:
▪ Garlic/green tea increase the hypoglycemic effect
Assessment:
● Administer with food to minimize gastric upset
● Excreted in the kidneys ⇒ monitor renal function
Teaching considerations:
▪ Teach s/s hypo- and hyperglycemic reaction
▪ Report vomiting, diarrhea, and rash
Glipizide (Glucotrol) [Class: 2nd Gen Sulfonylurea]
MOA: lowers blood glucose by stimulating beta cells to secrete insulin
o Side effects: major side effect is hypoglycemia
▪ s/s of insulin reaction: irritability, sweating, tremors, dizziness, confusion,
extreme hunger, and anxiety
o Interactions:
▪ No alcohol → increases half-life, can result in disulfiram-like reaction
▪ No ASA, anticoagulants, MAOIs, sulfonamides – increases action
